Post on 26-Dec-2015
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Symptom Relief
Terms
Pharmacodynamics The study of how a drug acts on a living organism.
Pharmacokinetics The study of how the body handles a drug over a period of time, including the
processes of: Absorption Distribution Biotransformation Excretion.
Pharmacology The science of drugs used to prevent, diagnose, and treat disease.
Toxicology The scientific study of poisons, their detection, their effects and treatments for the
conditions they create.
Drug Nomenclature Generic
Reflects the chemical structure of the drug Diazepam
Trade Also the brand name, is registered by manufacturer Valium
Official The official name used to list the drug Valium USP
Chemical The precise chemical description Chloro-1,3 dehydor, 1 methyl, 5 phenyl -2H, 1,4 benzodiazepine one
ASA Nitroglycerine Ventolin Epinephrine 1:1,000 Oral Glucose Glucagon Tetracaine (Alcaine, Diocaine…)
Medications given by the PCP
Sub-Lingual (Nitroglycerine)
Orally (ASA, Glucose)
Subcutaneous (Epinephrine 1:1,000, Glucagon)
Inhaled (Ventolin)
Intravenous
Endotracheal
Routes
6 Rights of Drug Administration
The Right Patient The Right Drug The Right Dose The Right Route The Right Time The Patients’ Right to Refuse
ASA Origin: Synthesized version of salicin found in the White
Willow tree
Class: Non-steroidal anti-inflammatory (NSAID); Analgesic; Antipyretic; Anti-coagulant
Action: Anti-coagulant effects: ASA inhibits Thromboxane A2 production which is
responsible for platelet aggregation. With the decrease in platelet aggregation the blood does not form clots as easily. The changes to the blood cell from ASA are irreversible, though the cell only lives from 5 to 7 days.
Other information: At high doses there is a direct stimulation of the respiratory center in the medulla which increases rate and depth of respirations (hyperventilation). You may also find increase of respiratory alkalosis from the hyperventilation as O2 consumption and CO2 production increase. Also at high doses ASA will block the secretion and reabsorption of uric acid.
ASA
Onset: 30 minutes Peak: 2 hours (6 - 8 hours with enteric coated) Duration: dose dependent
Indications: Ischemic Chest PainAcute MIUnstable Angina
Contraindications: SensitivityActive peptic ulcer
Side Effects: GI: Heartburn, N & V, diarrhea @ high doses, hemorrhage Renal: Necrosis of renal papillary with long term use Reye’s syndrome (a CNS infection relative to viral infection in children
such as chicken pox or influenza)
ASA
Precautions: History of Gastrointestinal ulcers Previous intake of daily aspirin Asthma (asthmatic patients may have hypersensitivity to ASA and
precaution should be taken with first time use, a good history prior to administration is essential)
Dose: 160 mg PO
Preparation: 80 mg tablets
Route: PO
Antidote: 500 mg/kg is fatalInduce vomiting and administer activated charcoal
Nitroglycerine Class: Nitrate, Antianginal
Actions: It was originally believed that nitroglycerin dilated coronary blood vessels, thereby increasing blood flow to the heart. It is now believed that atherosclerosis limits coronary dilation and that the benefits of nitrates are due to dilation of arterioles and veins in the periphery, reducing preload and to a lesser extent, after load.
Therefore: Relaxes vascular smooth muscle (Veins…arterioles. arteries)Decreases peripheral vascular resistance (PVR)Decreases myocardial workloadDecreases myocardial oxygen consumption (MvO2)
Onset/Peak/Duration: Onset: Spray/Tabs/IV: 1 – 3 minutes
Paste: 30 minutes Duration: 20 - 30 minutes
18 - 24 hours (paste)
Indications: Ischemic chest painHypertensionCongestive Heart Failure (CHF) (ICP and ACP only)
Nitroglycerine Adverse Effects:
CNS: headache, postural syncope Cardiovascular: reflex tachycardia, hypotension PNS: muscle twitching Integumentary: diaphoresis, skin rash GI: nausea, vomiting
Precautions/Interactions: Additive effects may occur with other vasodilators. Hypotension may result when combined with alcohol.
Contraindications: Relative: Glaucoma Absolute: Allergy
Hypotension (BP < 100/50 mmHg)Viagra usage 24 hours prior
If used within last 72 contact OLMCHypovolemiaHead injuryCerebral hemorrhage
Nitroglycerine
Preparation: spray bottle (0.4 mg per spray)
Dose: 0.4 mg SL q.5min (max of 3 doses)
Max Dose: No maximum (the administration of NTG SL should be titrated to
effect while maintaining blood pressure >= 100 systolic.)
Route: SL
Antidote: Manage nitroglycerin induced hypotension by terminating SL,
Trendelenburg position, and administration of NaCl bolus to reestablish normotensive state may be attempted if protocols allows
Epinephrine (1:1,000)
Type: Sympathomimetic; Sympathetic Agonist
Action: This drug acts directly on the (veins) and (1-heart, 2- lungs) receptor sites
in the heart, lungs, skeletal muscles, skin, kidneys, gastrointestinal tract, and other viscera.
There is a vasodilatation of the coronary arteries and the vessels of the lungs and skeletal muscles.
Epinephrine has an inhibitory effect causing widespread vasoconstriction in all other receptors sites within the body.
Therefore: Increased vascular resistanceIncreased BP and PulseIncreased coronary & cerebral flowIncreased MVO2
Increased automaticityBronchodilatation
Epinephrine (1:1,000)
Onset:< 2 minutes Peak: Is usually reached approximately 10 minutes after
administration. Duration: relatively short may require re-administration
to maintain therapeutic levels.
Indications: Severe Anaphylaxis
Contraindications: hypersensitivities no indications present
Precautions: None
Epinephrine (1:1,000)
Adverse Effects: Palpitations, anxiety, tremulousness, headache, dizziness, nausea and
vomiting. Due to its strong inotropic (force of contraction) and chronotropic (speed)
effects epinephrine increases myocardial oxygen demand. Hypertension, tachycardia Even low doses can result in myocardial ischemia.
Preparation: Ampules 1 mg/ml (1:1,000) Epipens 0.3mg/2ml (1:1,000 adult)
0.15mg/2ml (1:2,000 child)
Dose: Anaphylaxis: Adult 0.3 mg of 1:1,000 SC q 10-20 min
Child 0.01 mg/kg of 1:1,000 SC q 20 min
Antidote:There is no known antidote for epinephrine
Classification: β-2 agonist
Mechanism Of Action: β-2 stimulation causing smooth muscle relaxation of the bronchioles resulting in
bronchodialation Slight β-1 stimulation causing a possible tachycardia
Dosage: Adult > 30kg (66 lbs)
5.0 mg nebule with 8-10 lpm O2 4-6 puffs MDI prn
Peds 10-30kg (22 - 66 lbs) 2.5 mg nebule & 8-10 lpm O2 2-3 puffs MDI
Infant < 10kg (< 22 lbs) 1.25mg nebule & 8-10 lpm O2
Indications: WheezingAnaphylaxis
Salbutamol
Contra-Indications: Allergy Ischemic chest pain
Side effects Tachycardia, Hypertension Tremor, Headache Dry Nose, throat Arrhythmias
Supplied 5.0 mg nebules (2.5 mg/ml) 90 - 100 μg MDI
Precautions Vital signs before Transport must not be delayed
Salbutamol
Classification: Anti-hypoglycemic
Mechanism Of Action: Provides glucose to the system to allow for proper metabolism
Dosage: 1-2 tubes PO
Indications: Hypoglycemic patient with Glucose less < 4.0
Glucose
Glucose
Contra-Indications: No indications present Loss of gag reflex
Side effects May progress to hyperglycemia
Supplied 24 g tubes of carbohydrates
Precautions Should be given to conscious patients
Classification: Anti-hypoglycemic
Mechanism Of Action Stimulates glycogen release from the liver.
Dosage: 1.0 mg SQ Mid Deltoid area
Indications: Hypoglycemic patient with altered Level of consciousness & Glucose
less <4, Unable to start IV & give D50 Unable to give sugar PO
Glucagon
Glucagon Contra-Indications:
No indications present Allergy History of pheochromocytoma
Side effects nausea, vomiting Dizziness Possible BP Changes
Supplied 2 vials #1 1.0 mg powder #2 1.0 cc of diluting solution
Precautions Do not dilute powder with saline
Tetracaine
Classification: Xylocaine Family
Mechanism Of Action: Topical Anesthetic Stabilizes membranes of conjunctival and corneal pain fibers to
inhibit depolarization and perception of pain
Dosage: 2-3 gtts in affected eye(s)
Indications: To allow flushing of the eye
Contraindications: Possible penetrating injuries Allergy to local anaesthetics
Tetracaine
Supplied: Single disposable ampules
Side effects: May briefly increase eye irritation
Precautions: Removes patient’s blink reflex
Charcoal
Classification: None (Prevention of Toxic Absorption)
Mechanism Of Action: Binds to most toxins or poisons Reabsorbs poisons from liver or GI tracts
Dosage: Adult: 1.0 – 2.0 g/kg Pediatric: 1.0 g/kg
Indications: Alert and cooperative Pts who have ingested a toxic substance
Contraindication Acid/alkali ingestions Patient not alert/cooperative No bowel sounds
Charcoal
Side effects: Constipation
Supplied: Bottles of 50 g
Precautions: Stains clothing Not effective against
Lithium or Acids/Alkali
Calculations
Amount to be administered in volume=
Want/Have X Volume
Ex: give 0.1 ml/kg to a 70 kg ptvial comes 10 mg/5 ml
0.1 mg/kg X 70 kg=7.0 mg
(7.0 mg/10 mg) X 5.0 ml=3.5 ml